The burden of heart disease falls unequally on Maori and Pasifika, a fate further compounded in isolated and high deprivation areas.
Improving heart health inequities among people in Tairawhiti is at the forefront for a cardiology team in Gisborne who ran remote clinics up the East Coast in October.
Hauora Tairawhiti's director of cardiology Dr Gerry Devlin said they had been looking at their services and how they could operate differently.
“If you do it the same way, you're going to get the same answers.
“Bringing the service to the community, we think is an important way of making it easier to engage with us.”
A few weeks after the clinic, a patient up the Coast called the hospital.
“She was phoning up to express her gratitude. She said she hadn't felt so well in such a long time. She felt back to normal,” Dr Devlin said.
“That person, it's no trivial matter that we've made a difference to someone who, goodness knows if or when we would have got to see her through the normal model.”
Their team saw 26 patients over two days in Te Puia and Ruatoria. Eighteen patients were Maori.
It played out very differently to a decade ago when they struggled to fill the visiting clinics.
A key difference, and one which they believe was pivotal to the success of the recent clinic, were the relationships which had been built with Ngati Porou.
“Part of what we've done in the past two years is building relationships with the communities and being asked to come up and do the clinics is a testament to this,” Dr Devlin said.
Health workers were often intense and passionate about addressing inequities, and beelined straight for solutions, he said.
“Lots of people in health, we want to get on and solve things, but solving things is much more challenging than going in and saying ‘hey, I've got a solution for you',” Dr Devlin said.
“Relationships are really important.
“And the trust of the East Coast people,” added cardiology nurse practitioner Tracy Low.
In Dr Devlin's role as medical director of the Heart Foundation, they presented a paper on heart health and equity to the Government pre-election.
“We know there's inequity in heart health around the country. We know that the burden of heart disease falls unequally on Maori and Pasifika, and we know that it's compounded further when you go to rural, remote New Zealand,” Dr Devlin said.
High social deprivation doubles the likelihood of avoidable heart disease and these were all factors affecting communities up the coast, he said.
Maori health provider Ngati Porou Hauora chief executive Rose Kahaki said cardiac problems were a “big issue” for whanau living on the Coast.
They had held specialist clinics in Te Puia over many years and had seen increased attendance, but their ability to offer specialist care “closer to home” was dependent on two important factors:
“The interest of the doctor to service the coast and the district health board's willingness to fund the service,” she said.
This clinic was “very successful” and they were looking to apply the same model to other areas such as obstetrics and gynaecology and ophthalmology, Ms Kahaki said.
According to the Heart Foundation, Maori and Pacific people are 1.3 times more likely to suffer a heath attack or stroke, and four times more likely to die of heart disease before the age of 65 than non-Maori.
New Zealanders living in the most deprived areas are twice as likely to die from avoidable heart disease before the age of 65 compared to the least deprived.
Gisborne scores high on the social deprivation index, with income levels below national medians.
Ms Kahaki said they were moving into a “more proactive rather than reactive space” to address health inequities.
“We are working through plans at the moment to support whanau better from a wellness and preventative to treatment continuum.
“First this involves understanding the unique make-up and strengths of each community and using it as part of the solution.”
They were setting out to learn from models with better outcomes than their own, and understand the health of each person and community through collecting baseline data and tracking progress over time, she said.
Another element was supporting their workforce to better support whanau through training, education and mentoring.
This also comes as Ms Low qualifies as Tairawhiti's first cardiology nurse practitioner — an advanced nursing role with the licence to diagnose, investigate and be the lead clinician.
Ms Low said they were looking at running the cardiology service up the coast more regularly.
“The community up the coast has been underserviced for so many years, we need to make sure that whatever we say that we're going to do, we do it.”
“It does come down to the sustainability of our services, our clinicians and our skills.”(external link)